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Wednesday, February 12, 2014

SME's and the future of Health Care in our Communities

It’s been almost imperceptible, and yet it’s been quite dramatic. I’m not talking about the Internet, Facebook or even Twitter, although they have played a significant role in the social changes that we see and read of, each and every day.

I’m talking about Health Care.

Notice, I’m not talking about Sickness, Disease or Accident care, but about Health Care.
Now …
If you were to time travel back to the post war period in any western country, you went to the Doctor because you were sick. The Doctor would invariably know your Mother and your father and may even have brought you into the world you at the local hospital or perhaps at home. And if you were really sick that Doctor would almost certainly have visited you in your own home … and probably stayed on for a cup of tea too. However it wasn’t all Nirvana back then in GP land, because in all likelihood, your Family Doctor would have sat at the side of your bed smoking a pipe - but I digress.

Over the ensuing decades, with the massive increase in technology that was associated with medical diagnostics, plus all the paramedics that are vital to the normal running of our current Health Care systems, the cost of providing health care services has sky rocketed. So the emphasis on so-called Preventative medicine became the norm, with the logical precept that if you reduce risks for certain chronic medical conditions - such as Heart disease, Diabetes, Cancer and many others - then the savings accrued would reduce the future burden of burgeoning health care costs. And we’re talking of billions of dollars here.

So it became the norm for GP’s to promote Preventative Medicine as the way forward, as they were seen to be in the ideal position with their knowledge of medicine and of their patients. But then two invisible forces began to collide.

The time it takes to action many of these preventative screening programs started to eat into the time that the GPs actually had to see sick patients. Because not only did they have to go through a particular screening process, they then had to document it all. All of which does not fit neatly into a 15 to 20 minute standard consultation.

Secondly, GPs had stopped visiting patients in their homes. And because so many GPs were now part-timers, continuity of care was rapidly disappearing too. That has led to the current situation where many time poor GPs do not know the social or family history of their patients, apart from what the previous treating GP had written in the patients electronic notes.

Pity the poor patient then who has a high fever and needs to get back to work as fast as possible, but can’t get in to see the Doctor for 3 or 4 days because the Doctor is “Booked out”. And when they do get an appointment, they are often left sitting in a crowded waiting room where cross infection is a real possibility.

The challenge as I see it is to get GPs to see those who need a Doctor - the sick people of our communities: and to create an environment where people can access real Health Care in the places where they spend most of their time - the places where they go to work.

People will visit the Doctor maybe two or three times a year, but they will often see a different Doctor each time. Those same people go to the same workplace up to five days a week for about eight hours each day: in fact they actually live and work in a little community. And its inevitable that after a period of time, each persons family and social history is known to their fellow workmates.

Today most, if not all large corporations will be offering a whole range of healthy living programs to their staff, because they know that it’s an investment in their most vital resource - the people who work for them - and in nearly all those cases this investment in their staff also helps the financial bottom line too.

However, over 90% of the National Workforce work in small to medium sized enterprises - or SMEs - and the vast majority of these do not have the resources or the skills to enact Healthy living programs for their limited staff numbers. There is no doubt that some employers would see such intervention programs as an extra headache, and it may be that some staff would even see it as a threat. But the benefits of creating a healthy work environment and encouraging the employers and employees to live a healthy lifestyle too, are not just limited to the SMEs themselves. International reviews suggest that it could have far reaching economic benefits for the wider community as well. Dame Carol Black, National Director for Health, Work and Wellbeing, in the UK has calculated that improved workplace health could generate cost savings to the British government of over £60 billion – the equivalent to nearly two thirds of the NHS budget for England. And these figures would no doubt be somewhat similar all around the developed world.

Thus it seems logical for people who are sick to be seen by people who are trained to investigate and treat people who are sick. And it would also seem logical that businesses who need healthy workers to operate efficiently, should be committed to promoting healthy lifestyle for those workers.
The spin offs from such initiatives would include

Better health for the national workforce - in other words the vast majority of the population - with reduced risk of chronic health issues.
More time for Doctors to do their “Doctoring”
Massive savings in the future for the Health care industry allowing scarce Health care dollars to be targeted at areas of most need.
Significant savings for businesses who promote healthier workers: and the reputation of being seen as an employer of choice who cares for their employees.

So how does this work?

Firstly each SME needs to identify the needs of their particular business. Hairdressers would have different needs to a plumber and a car mechanic would have different needs to an office worker, so some basic data collection is needed before any thought to a particular program is started.

Once this data has been collected and a health care initiative identified, then a structured program needs to be set up and monitored. There is absolutely no point in starting something new if you don’t monitor it and review your results regularly. Without monitoring and review there is no way of assessing whether the program is effective, and that will inevitably lead to frustration and abandonment of a potentially helpful program. Involve your staff in gathering information and in choosing an appropriate program, then it’s far more likely to succeed.

If you find that your business is “too small” to consider such an idea, then form a cooperative with other small businesses in your area or within your trade, or contact the small business associations in your town or city. The small effort you put in will result in positive outcomes for you and ever bigger rewards for the wider community as time goes on.

Changing peoples patterns of life is a slow business. But if someone had told me of the huge changes that I’ve witnessed during the course of my medical career I probably wouldn’t have believed them. But I do believe that SMEs are the key to how we can change the health of our countries. And it only takes each of us to dare to do our little part, and then the resulting impact will be massive and long lasting.

Interesting concept. I remember the days where the doctor came to the house - he's the one who treated me for pneumonia the night before my wedding. Those days are gone forever in the US and I don't ever see a plan like your's happening here either. Our system is seriously flawed and has been for a few years. Something needs to change.